Welding & Industrial Supply, Inc

  2319 W. 8^th, Coffeyville, KS 67337            3700 E Tuxedo, Bartlesville, OK 74006 

PH(620)251-1740  Fax(620)252-6390            Ph(918)333-5656  Fax(918)333-5657     

Authorization for Release of Information

I understand that before being considered for employment a full background check will be preformed.  This check may include gathering information from previous employers, references, educational institutions and creditors.  This information will be held in confidence and used only for consideration for employment as allowed by law.

I hereby give the right to Thompson Brothers Supply, Inc. to contact and obtain information from all references, employers, educational institutions, creditors and to otherwise verify the accuracy of the information contained in my application.  I hereby release from liability Thompson Brothers Supply, Inc. and its representatives for seeking, gathering and using information and all others persons, corporations or organizations for furnishing such information.

Applicants Full Name:______________________________________________  

            (Please Print)

Signature of Applicant:_____________________________________________

Date: _____ /_____ /_____      Social Security Number: _____-_____-_____